The ED Major Incident Center: A Perfect Refit

     Emergency departments are facing overwhelming challenges in delivering care to their daily patient volumes, much less patients from major incidents. Inpatient beds are in short supply in most metropolitan areas, backing patients up into EDs. Hospitals are under tremendous budget constraints and fiscal pressures such as malpractice liabilities and staffing costs. The public is concerned about its access to emergency care. Yet communities are seeking ways to invest in preparedness, and the public understands the importance of funding the rescue agencies that provide its safety-net services.

     How can we help our hospitals while answering the need for better preparedness? With a major investment in our emergency departments.

     There are currently around 3,900 EDs in the country; they serve about 110 million patients a year for all forms of illness and injury. Essentially every one of these EDs needs to be refitted for a new role in community surveillance and major incident medical care. This represents an opportunity for joint investment by federal, state and local governments-carried out in conjunction with the many businesses, charitable organizations and individuals who want new levels of emergency preparedness in their communities-to address two important and pressing problems at once. Our EDs can serve as major incident centers in times of outbreak, disaster or attack, while our hospitals are stabilized by a needed investment in their infrastructure and capabilities.

     Here's what such a system would look like.

Painting a Regional Picture
     Emergency departments across the country are required to have certain elements:

• Appropriate supplies, equipment and disposable patient-care items;
• Appropriate facilities for the management of major-incident casualties;
• A consistent manner of patient check-in, symptom evaluation, triage and processing.

     Under an enhanced system, area EMS providers should use a similar system, so that a regional picture of unscheduled patient presentations can be developed. This combined data would simultaneously feed a syndromic surveillance system and a regional coordination center, with experts watching incoming data for patterns of injury or illness that may require immediate management, such as public-safety or public-health activation. The utilities industry can provide models for regional surveillance, coordination and major-incident management.

Have-to Haves:
    Critical design components of ED major incident centers would include:

• A facility design friendly to communities and patients;
• Capabilities for safe management of patients contaminated or exposed to hazardous substances;
• Information systems linked with regional healthcare coordination centers;
• Links to the community's out-of-hospital emergency system;
• All other major incident preparedness elements.

Other Capabilities
     A consistent approach should be used for ED major incident centers. A center should "wrap around" its hospital's existing emergency department.

     It must provide a consistent approach to greeting incoming emergency patients, every day and in the event of a major incident. The greeting system should be designed to safely manage incoming EMS and ambulatory patients, and facilitate the systems that must survey for syndromes related to natural outbreaks of disease or heralding terrorist or criminal activity. The center will house the supplies needed for multiple-casualty incidents throughout the community, including the new wave of detection systems needed to identify hazardous chemical, biological and radioactive agents.

     Local government should contribute support for necessary roadway changes, zoning approvals and movement of public utilities that surround and feed the hospital (and upgrades of their durability) and facilitate the cooperation of local public-safety agencies in performing necessary community emergency medical preparedness planning.